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General NPI Number Information
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NPI Number | 1366636938
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Entity Type | Individual
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Provider Name | LEESA DIANE SWAGGERTY RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 990 OAK RIDGE TPKE
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City | OAK RIDGE
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State | TN
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Zip | 37830-6976
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Country | US
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Telephone | 865-835-4118
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Fax | 865-835-4122
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Provider Business Mailing Address
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Address Line | 9605 MARLEY LN
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City | KNOXVILLE
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State | TN
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Zip | 37922-5874
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Country | US
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Telephone | 865-835-4118
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Fax | 865-835-4122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDN0000001014
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License Number State | TN
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